Background High Flow Nasal Cannula (HFNC) oxygen is used to deliver heated and humidified mixture of air and oxygen at a flow higher than the patient’s inspiratory flow. It reduces respiratory distress and mouth dryness. The greater oxygen flow ‘washes out’ the end expiratory oxygen depilated gas, meaning with the next breath, the patient inhales more oxygen. This dead space wash out also reduces CO2 rebreathing. Reductions in rates of intubation in infants with bronchiolitis have also been reported following introduction of HFNC therapy; however research remains limited within paediatrics and it has been used in patients with conditions, other than bronchiolitis. In our District General Hospital (DGH), we have a guideline for use of HFNC in patients with bronchiolitis but not for use in other respiratory disease. The use of HFNC for the latter group is at individual consultant discretion after discussion with Paediatric Intensive Care
What were the incidence, indication, demographics, duration and outcome of patients who received HFNC therapy on the Children’s ward in Craigavon Hospital over a 6 month period from October 2019 to March 2020?
When patients received HFNC therapy outside our current indication, were they discussed with PICU in terms of suitability to initiate or continue therapy in the children’s ward?
Was there a delay or perceived delay in escalation of treatment to tracheal intubation in those who had treatment failure on HFNC?
Methods This was a retrospective chart review. Patient demographics, indication, duration of treatment and outcome are recorded in a pre-designed proforma
SHSCT Research Governance team advised this is a service evaluation quality improvement which did not require ethics approval (Appendix 2).
Treatment success was defined as ‘patient improving on HFNC with successful weaning of respiratory support.’ Treatment failure was described as the ‘patient deteriorating despite treatment and requiring admission to PICU’
Results are tabulated in XCEL format, analysed and conclusions drawn with recommendations
28 children required HFNC therapy over a 6 month period with peak activity in November 2019
Male to female ratio was 3.5:1
Commonest indication for use (85% cases) was bronchiolitis
Comorbidities were seen in 50% of the cases with commonest being prematurity
All patients receiving HFNC outside agreed indications were appropriately discussed with PICU
HFNC treatment success rate was 79%
Conclusions Our study showed that HFNC has been largely successful in managing patients on the general paediatric ward reducing admissions to Paediatric Intensive Care in 79% cases
Most common indication for its use remains Bronchiolitis recommendations and future implications
To continue the collaborated approach when initiating HFNC therapy in a DGH particularly when indications are outside the current guidance.
This observational study was undertaken in the ‘Pre-COVID’ period. This year the Royal College of Paediatrics have endorsed a guidance including indications and contraindications, assessment 1 hour post therapy to detect responders and treatment failures and rapid weaning pathway. We plan to undertake a prospective analysis of high flow nasal cannula oxygen use this winter and compare results.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.